Elinzanetant has Groundbreaking Impact on Hot Flashes and Quality of Life, suggests study

The nonhormonal drug elinzanetant showed substantial benefit for hot flashes, sleep disturbance, and quality of life in data from three randomized controlled trials presented at The Menopause Society 2024 Annual Meeting in Chicago. OASIS 1 and 2 trials were published in JAMA, and the OASIS 3 trial was presented as a poster at the conference. Recent research paper summarizes the findings from three randomized controlled trials (OASIS 1, 2, and 3) evaluating the efficacy and safety of the investigational drug elinzanetant for the treatment of vasomotor symptoms associated with menopause.

Elinzanetant Mechanism and Trial Design

Elinzanetant is a selective neurokinin receptor antagonist that targets the estrogen-sensitive kisspeptin/NK B/dynorphin (KNDy) neurons, which are thought to play a role in thermoregulation and hot flashes during menopause. The OASIS 1 and 2 trials enrolled postmenopausal women aged 40-65 years with at least 50 moderate to severe vasomotor symptoms per week. They were randomized to receive either 120 mg of oral elinzanetant or placebo once daily for 12 weeks, after which the placebo group switched to elinzanetant for the final 14 weeks.

Findings from Elinzanetant Trials

The results showed that elinzanetant led to a significant reduction in the daily frequency and severity of vasomotor symptoms compared to placebo. Elinzanetant also significantly improved sleep disturbance and quality of life measures. The OASIS 3 trial, which assessed elinzanetant for 1 year, supported the findings from the earlier trials, demonstrating sustained efficacy over a longer duration.

Safety Considerations

Regarding safety, the most commonly reported adverse events with elinzanetant were headache, fatigue, and sleepiness. A higher proportion of elinzanetant users discontinued the study compared to placebo. However, there were no serious adverse events deemed treatment-related, and no evidence of endometrial hyperplasia, malignancy, or liver toxicity.

Potential Role of Elinzanetant

The authors suggest that elinzanetant may be a useful option for women who cannot or prefer not to use hormone therapy, including those with a history of estrogen-sensitive cancers, venous thromboembolism, or migraines with aura. The dual targeting of the NK-1 and NK-3 receptors by elinzanetant, in contrast to the NK-3 receptor-specific fezolinetant, may contribute to the broader improvements observed in vasomotor symptoms, sleep, and quality of life.

Key Points

1. The research paper summarizes the findings from three randomized controlled trials (OASIS 1, 2, and 3) evaluating the efficacy and safety of the investigational drug elinzanetant for the treatment of vasomotor symptoms associated with menopause.

2. Elinzanetant is a selective neurokinin receptor antagonist that targets the estrogen-sensitive kisspeptin/NK B/dynorphin (KNDy) neurons, which are thought to play a role in thermoregulation and hot flashes during menopause. The OASIS 1 and 2 trials enrolled postmenopausal women aged 40-65 years with at least 50 moderate to severe vasomotor symptoms per week, and randomized them to receive either 120 mg of oral elinzanetant or placebo once daily for 12 weeks, after which the placebo group switched to elinzanetant for the final 14 weeks.

3. The results showed that elinzanetant led to a significant reduction in the daily frequency and severity of vasomotor symptoms compared to placebo. Elinzanetant also significantly improved sleep disturbance and quality of life measures. The OASIS 3 trial, which assessed elinzanetant for 1 year, supported the findings from the earlier trials, demonstrating sustained efficacy over a longer duration.

4. Regarding safety, the most commonly reported adverse events with elinzanetant were headache, fatigue, and sleepiness. A higher proportion of elinzanetant users discontinued the study compared to placebo. However, there were no serious adverse events deemed treatment-related, and no evidence of endometrial hyperplasia, malignancy, or liver toxicity.

5. The authors suggest that elinzanetant may be a useful option for women who cannot or prefer not to use hormone therapy, including those with a history of estrogen-sensitive cancers, venous thromboembolism, or migraines with aura.

6. The dual targeting of the NK-1 and NK-3 receptors by elinzanetant, in contrast to the NK-3 receptor-specific fezolinetant, may contribute to the broader improvements observed in vasomotor symptoms, sleep, and quality of life.

Reference –

Pinkerton JV, Simon JA, Joffe H, et al. Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause: OASIS 1 and 2 Randomized Clinical Trials. JAMA. Published online August 22, 2024. doi:10.1001/jama.2024.14618

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Lamotrigine useful alternative to Mexiletine for Non-dystrophic Myotonias: Lancet

A recent groundbreaking trial conducted in London United Kingdom
revealed that lamotrigine is as effective as mexiletine and can be used as
an alternative drug for non-dystrophic myotonias. The trial results were
published in the journal The Lancet Neurology.

Non-dystrophic myotonias are a group of rare genetic
neuromuscular disorders stemming from ion channel dysfunction. They
predominantly occur in the first two decades of life leading to lifelong
morbidity. They affect skeletal muscle relaxation and typically affect the legs.
There is no cure for this condition except for symptomatic management which
includes usage of sodium channel blockers. Research done in the past has shown
that Mexiletine which is a sodium channel blocker can be used symptomatically
to improve the quality of life. Recent research has also shown the
effectiveness of lamotrigine for the symptomatic management of myotonias.
Hence, researchers conducted a head-to-head trial to compare mexiletine and
lamotrigine and the non-inferiority of lamotrigine.

Also Read: Treatment of bipolar disorder with valproate and antipsychotics linked to risk of diabetes mellitus

A randomized, double-blind, crossover, non-inferiority,
phase 3 trial was carried out at the National Hospital for Neurology and
Neurosurgery (London, UK) by including individuals aged ≥18 years who had
genetically confirmed symptomatic non-dystrophic myotonia. The participants
were randomly assigned (1:1), employing a block randomization schedule created
by a computer program, to receive either mexiletine for 8 weeks followed by
lamotrigine for 8 weeks, or lamotrigine followed by mexiletine, with a 7-day
washout period in between.

Masking of the investigators and participants was done
during treatment allocation. The primary outcome measure was the mean
interactive voice response (IVR) diary stiffness score (0–9 scale) over the
participant’s final 2 weeks of diary reporting in each treatment period. A
mixed-effects model was used to assess the non-inferiority with a predefined
margin of 0·5 and included all randomly assigned participants who contributed
at least 7 days of IVR-diary data in either treatment period.

Findings:

  • About 60 participants were screened (24 females
    and 36 males) and randomly assigned between Aug 1, 2021, and Dec 12, 2022, to
    either the mexiletine–lamotrigine sequence (n=30) or the lamotrigine–mexiletine
    sequence (n=30).
  • Among them, 53 participants contributed data to
    the primary analysis.
  • Post-treatment with the drugs, the mean IVR
    stiffness score with mexiletine was 2·54 versus 2·77 with lamotrigine (mean
    mexiletine–lamotrigine difference −0·23).
  • Indigestion–reflux was the most common adverse
    event reported (eight participants, 208 participant-days receiving mexiletine;
    seven participants, 130 participant-days receiving lamotrigine).
  • No serious adverse events were reported.
Also Read: Levetiracetam More Effective Than Lamotrigine for Epilepsy Treatment in Young Women

Thus, the trial concluded that lamotrigine was as effective
as mexiletine. Despite the lack of definitive evidence for non-inferiority both
the medications displayed similar efficacy. This suggests that lamotrigine can
be used as an alternative to mexiletine. This trial offers critical insights for
clinicians to offer therapeutic options to patients based on patient’s
acceptance.

Further reading: Vivekanandam V, Skorupinska I, Jayaseelan
DL, et al. Mexiletine versus lamotrigine in non-dystrophic myotonias: a
randomised, double-blind, head-to-head, crossover, non-inferiority, phase 3
trial. Lancet Neurol. 2024;23(10):1004-1012.
doi:10.1016/S1474-4422(24)00320-X

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Seizures among children swallowing medications or illegal substances doubled over 15-year period: Study

Copenhagen: New data shows that the number of children suffering a seizure after swallowing medications or illegal substances has doubled between 2009 and 2023 in the US.

The findings were presented today (Wednesday) at the European Emergency Medicine Congress.

The most common substances involved in these poisonings include over-the-counter antihistamines, prescription antidepressants and painkillers, and illegal synthetic cannabinoids.

Dr Conner McDonald from the University of Virginia School of Medicine told the Congress: “Seizure is one of the most severe symptoms a poisoned patient can experience, and children are particularly vulnerable. Depending on variables such as where a seizure happens, how long it continues and the pre-existing health of the child, seizures can lead to long-term damage or even death.”

Working with Professor Christopher Holstege, Chief of the Division of Medical Toxicology at the University of Virginia School of Medicine, and colleagues, Dr Farah gathered data from the US National Poison Data System on seizures in children and teenagers (under the age of 20 years) that resulted from exposure to any single substance between 1 January 2009 and 31 December 2023.

The National Poison Data System brings together information from the 55 poison centres across the US. These centres are consulted in the most serious cases of poisoning, including poisoning in children that results in seizure.

The researchers analysed the data according to the children’s ages and the substance they had consumed. Overall, they found that cases had increased from 1,418 in 2009 to 2,749 in 2023, corresponding with an average yearly increase of five per cent.

Among children aged between six and 19 years, the number of cases had doubled over the 15-year period. In children under six years, there was a 45% increase in cases over the 15-year period.

The substances responsible for most of this increase include diphenhydramine (an over-the-counter antihistamine commonly used for allergies, hay fever and nasal congestions), tramadol (an opioid prescribed for pain in adults), bupropion (an antidepressant prescribed for adults and children), and synthetic cannabinoids known as K2 or spice (illegal substances that are man-made and chemically similar to substances found in the cannabis plant).

Dr McDonald explained: “Diphenhydramine can be purchased in the United States in bottles containing 500 or 600 tablets. Bupropion is being more frequently prescribed to treat depression in adults and children. Other legal and illegal drugs can be bought online and shipped around the world. Therefore, these drugs are becoming more available in homes and within the reach of children.”

Speaking before the Congress, Professor Holstege said: “The increase in seizures in children exposed to these drugs is extremely worrying and must be addressed. It’s a stark reminder to parents and carers to store medications safely so that children cannot get hold of them.

“In the US, we also need to have a serious discussion on whether products like diphenhydramine should be sold in containers with such large quantities of pills and whether these products should be contained within blister packs to make it more difficult for children and suicidal individuals to gain access to such a large quantity.”

Dr Barbra Backus is chair of the EUSEM abstract selection committee. She is an emergency physician in Rotterdam, The Netherlands, and was not involved with the research. She said: “The increase in drug poisoning among children is worrysome. Although these data are for the US, we know that drugs are the most common sources of poisoning in children around the world. It is important that we keep looking for safer distribution and storage of medication. Blister packs and child-resistant pill bottles can help, but all drugs, whether they are over the counter, prescribed, or illegal should be kept out of reach or locked away where children cannot access them.

“No parent or carer ever wants to see their child suffer a drug-induced seizure, especially when it could have been prevented.”

Seizures caused by children swallowing medications or illegal substances doubled over 15-year period European Emergency Medicine Congress (EUSEM 2024)

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Hot news flash: Menopause can impact woman’s heart health

The risk of heart disease increases with age for most people, however, for women that may be even more true. The menopause transition, those years leading up to and through menopause, is a time of increasing heart disease risk, according to an American Heart Association scientific statement published in the flagship journal Circulation in 2020.

“While many people think that breast cancer is the leading killer of women in the U.S., in reality heart disease kills more people than all cancers combined,” said Garima Sharma, M.D., FAHA, a volunteer of the American Heart Association. “One in 39 women in the U.S. dies from breast cancer each year, while 1 in 3 dies from cardiovascular disease. That’s roughly one death each minute – and we know that menopause plays in important role in a woman’s cardiovascular disease risk.”

Sharma notes that women face unique risks related to cardiovascular health at every stage of life, the years before and after menopause are a critical time to be aware of and address the increased risks related to heart disease and stroke.

“Menopause is a natural phase of life for most women in their 40s or 50s, but it’s never too early to start learning about how the significant hormonal and physiological changes impact your heart health even in your younger years. In fact, being heart healthy as you head into menopause may reduce later risks,” said Sharma who is director of women’s cardiovascular health and cardio-obstetrics at Inova Health System in Fairfax, Virginia.

A number of studies presented at the American Heart Association’s scientific meetings or published in the Association’s medical journals note the increased risk of cardiovascular disease and other health complications during various stages of menopause:

  • After menopause an estimated 1 in 4 women may develop irregular heart rhythms – known as atrial fibrillation – in their lifetime, with stressful life events and insomnia being major contributing factors, according to one study published in the Journal of the American Heart Association (JAHA).
  • Another JAHA study found that obesity significantly increased heart failure risk among women who experienced late menopause – at age 55 or older,
  • A study presented at the Association’s 2022 Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Conference (EPI), found that women who naturally entered menopause by the age of 40 had a 40% increased risk of developing coronary heart disease over their lifetime, compared to women who did not go through early menopause.
  • A separate study presented at the 2021 EPI meeting found that women who experience very early menopause were 35% more likely to develop some type of dementia later in life, compared with women who enter menopause around age 50.
  • Another 2021 EPI meeting study found that social isolation and loneliness may increase cardiovascular disease risk by 29% in post-menopausal women.

Sharma noted that menopause does not cause cardiovascular disease; however, during the menopausal transition women experience many changes in their bodies, including some that can impact their cardiovascular health:

  • Decline in estrogen levels
  • Hot flashes and night sweats
  • Depression
  • Sleep problems
  • Increased body fat around the organs
  • Increased cholesterol levels
  • Stiffening or weakening of the blood vessels

“More women in the U.S. are living longer, and a significant portion of them will spend up to 40% of their lives postmenopausal, so it’s important to monitor a woman’s health and lifestyle and develop intervention strategies to protect heart health,” Sharma said. “Solutions won’t be one-size-fits all. This is an area where there is a big need for personalized, preventive cardiology care for women focused on lowering cardiovascular risk.”

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Unraveling Factors Influencing Emergency Intervention for Airway Obstruction in Internal Medicine: Study

Airway blockage poses a critical emergency and poses substantial challenges for healthcare providers, as effectively managing this condition requires precise decision-making. Numerous patients with airway obstruction necessitate interventions beyond the confines of the operating room, each carrying distinct risks. Recent paper investigated factors associated with emergency interventions in acute airway obstructive diseases (AAODs) in internal medicine conditions. The study was a retrospective observational single-center study that included 150 patients admitted to Yokosuka Kyosai Hospital, Japan, for AAOD between April 2012 and March 2022. The study aimed to identify predictors for emergency interventions such as intubation, cricothyroidotomy, and tracheostomy in patients with AAODs.

Results revealed several significant findings from univariate analysis, including age, Glasgow Coma Scale, respiratory rate, National Early Warning Score (NEWS), Sequential Organ Failure Assessment (SOFA) score, stridor, dysphagia, drooling, frequent suctions, airway examination abnormalities (AEAs), and diagnosis. Multivariate logistic regression indicated that AEA, upper airway diseases, and SOFA score were predictors for intervention, with AEA being associated with the highest risk for airway interventions. However, the study found that the sensitivity and specificity of AEA were insufficient.

Diseases and Predictive Factors

The paper also discussed various diseases that can lead to airway emergencies, such as acute epiglottitis, peritonsillar abscess, tonsillitis, pharyngitis, Lemierre’s syndrome, hemoptysis, and airway foreign body. It highlighted the importance of thorough physical examinations in predicting airway interventions and the need for accurate diagnostic methods in emergency settings.

Limitations and Further Research

The authors mentioned the limitations of the study, including its retrospective nature and the need for a multicenter study to confirm the results. They also discussed the importance of physical examinations in predicting airway interventions and the need for future prospective studies to overcome the study’s limitations.

Conclusion

In conclusion, the paper identified AEA, upper airway diseases, and SOFA score as predictors for emergency interventions in AAOD. However, it highlighted the limitations of these predictors and the need for further research to improve the accuracy of predicting interventions for AAOD.

Key Points

– The study investigated factors associated with emergency interventions in acute airway obstructive diseases (AAODs) in internal medicine conditions.

– It was a retrospective observational single-center study involving 150 patients admitted to Yokosuka Kyosai Hospital, Japan, for AAOD between April 2012 and March 2022.

– The study aimed to identify predictors for emergency interventions such as intubation, cricothyroidotomy, and tracheostomy in patients with AAODs.

– Factors associated with emergency interventions included age, Glasgow Coma Scale, respiratory rate, National Early Warning Score (NEWS), Sequential Organ Failure Assessment (SOFA) score, stridor, dysphagia, drooling, frequent suctions, airway examination abnormalities (AEAs), and diagnosis.

– AEA, upper airway diseases, and SOFA score were identified as predictors for intervention, with AEA being associated with the highest risk for airway interventions, but with insufficient sensitivity and specificity.

– Diseases such as acute epiglottitis, peritonsillar abscess, tonsillitis, pharyngitis, Lemierre’s syndrome, hemoptysis, and airway foreign body were discussed as conditions leading to airway emergencies, emphasizing the importance of thorough physical examinations and the need for accurate diagnostic methods in emergency settings.

Reference –

Suzuki N, Doi T, Abe T, et al. (October 07, 2024) Predictors of Emergency Interventions in Acute Airway Obstructive Diseases: A Retrospective Single-Center Observational Study. Cureus 16(10): e71031. DOI 10.7759/cureus.71031

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‘Weekend warrior’ exercise pattern as good as frequent sessions for lowering cognitive decline risk: Study

Just one or two sessions of physical activity at the weekend-a pattern of exercise dubbed ‘weekend warrior’-may be just as likely to lower the risk of cognitive decline, which can often precede dementia, as more frequent sessions, concludes research published online in the British Journal of Sports Medicine.

And it may be more convenient and achievable for busy people as well, suggest the researchers.

It’s important to identify potentially modifiable risk factors for dementia because a 5-year delay in onset might halve its prevalence, they say, adding that nearly all the evidence to date comes from studies in high-income countries.

They therefore drew on two sets of survey data from the Mexico City Prospective Study, the first of which took place between 1998 and 2004, and the second of which took place between 2015 and 2019.

Some 10,033 people (average age 51) completed both surveys and their responses were included in the analysis.

For the first survey, respondents were asked whether they exercised or played sports, and if so, how many times a week, and for how long (in minutes).

Four groups were derived from the responses: the no exercisers; the ‘weekend warriors’ who exercised/played sports once or twice a week; the regularly active who did so three or more times a week; and a combined group comprising weekend warriors and the regularly active.

The Mini Mental State Exam (MMSE) was used to assess cognitive function at the time of the second survey. A score of 22 or less out of 30 was used to define MCI.

In all, 7945 respondents said they didn’t exercise at all; 726 fulfilled the definition of a weekend warrior; 1362 said they exercised several times a week; and 2088 made up the combined group.

During an average monitoring period of 16 years, 2400 cases of MCI were identified. MCI prevalence was 26% among the no exercisers; 14% among the weekend warriors; and 18.5% among the regularly active.

After taking account of potentially influential factors including age, educational attainment, smoking, nightly sleep, diet and alcohol intake, weekend warriors were 25% less likely to develop MCI than the no exercisers, while the regularly active were 11% less likely to do so. Those in the combined group were 16% less likely to do so.

When MCI was defined as an MMSE score of 23 or below, 2856 cases were identified. And MCI prevalence rose to 30% among the no exercisers, 20% among the weekend warriors, and 22% among the regularly active.

Compared with the no exercisers, weekend warriors were 13% less likely to develop MCI, while the regularly active and those in the combined group were 12% less likely to do so. The results were similar for both men and women.

The researchers estimated that, in theory, 13% of cases might be avoided if all middle aged adults exercised at least once or twice a week.

This is an observational study, so no firm conclusions can be drawn about causal factors. And the researchers acknowledge various limitations to their findings. For example, the survey respondents might not have been truly representative of middle aged adults and there were no objective measures of physical activity.

But there are several possible explanations for the seemingly protective effect of exercise on brain health, they explain.

“For example, exercise may increase brain-derived neurotrophic factor concentrations [molecules that support the growth and survival of neurons] and brain plasticity. Physical activity is also associated with greater brain volume, greater executive function, and greater memory,” they write.

“To the best of our knowledge, the present study is the first prospective cohort study to show that the weekend warrior physical activity pattern and the regularly active physical activity pattern are associated with similar reductions in the risk of mild dementia,” they continue.

And they go on to suggest that the findings “have important implications for policy and practice because the weekend warrior physical activity pattern may be a more convenient option for busy people in Latin America and elsewhere.”

Reference:

O’Donovan G, Petermann-Rocha F, Ferrari G, et alAssociations of the ‘weekend warrior’ physical activity pattern with mild dementia: findings from the Mexico City Prospective StudyBritish Journal of Sports Medicine Published Online First: 29 October 2024. doi: 10.1136/bjsports-2024-108460.

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Feeling Constipated? You May Have Higher Risk for Heart Disease, suggests study

People with constipation may have a higher risk of having a heart attack or stroke, and the risk increases in people who also have high blood pressure. The findings of a new study are published in the American Journal of Physiology-Heart and Circulatory Physiology. The study has been chosen as an APSselect article for October.

High blood pressure, diabetes, obesity, smoking and age are a few of the traditional risk factors for cardiovascular disease. A recent study of the connections between the heart and gut revealed that constipation-a condition that also increases with age-is associated with high blood pressure and cardiovascular disease. This heart and gut connection was independent of these traditional risk factors or medication used to treat high blood pressure such as calcium channel blockers.

In this study, the research team used data from over 400,000 people in the U.K. Biobank to determine if constipation could be an independent, nontraditional risk factor for cardiovascular disease. This database contains electronic medical records, lifestyle surveys, and self-reported health conditions and medication use data. Because the biobank contained limited information from nonwhite populations at the time of data collection, the current study is based on data from males and females of white European ancestry.

The researchers found 11.5% of people analyzed had experienced at least one major adverse cardiac event, with much higher rates in men (67.3% of all cases who had a cardiovascular event). Constipation rates overall were higher in women (55.9% of all cases).

More than 157,400 of the participants had high blood pressure and 8.6% of them were also diagnosed with constipation. Those with constipation “demonstrated a significantly increased risk of [major adverse cardiac events] compared with those with regular bowel habits,” the researchers wrote. This increased risk was adjusted for the use of constipating medications.

In addition, the researchers found genetic correlations in more than 9 million instances of genetic variations between constipation and major cardiac events, showing constipation shares 21% to 27% of genetic variants with cardiovascular disease. Genome analysis estimated constipation to be a heritable trait about 4% of the time.

Identifying the associations between constipation and heart disease can help scientists “discover new therapeutic interventions and implement more effective management strategies based on individual risk assessment in line with precision medicine principles,” the researchers wrote.

Reference:

Tenghao Zheng,Leticia Camargo Tavares,Mauro D’Amato, andFrancine Z. Marques, Constipation is associated with an increased risk of major adverse cardiac events in a UK population, American Journal of Physiology-Heart and Circulatory Physiology, https://doi.org/10.1152/ajpheart.00519.2024

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Study Reveals Amniotic Membrane Grafting Effective for Moderate Ocular Burns, Limited in Severe Cases

USA: A recent report by the American Academy of Ophthalmology has shed light on the potential benefits of amniotic membrane grafting (AMG) in treating chemical and thermal ocular surface injuries. This innovative approach has garnered attention for its ability to aid in the healing process following acute ocular surface burns.

“The most reliable level II evidence indicates that AMG is effective in accelerating re-epithelialization for moderate acute ocular surface burns. However, when used as an adjunct to medical therapy, it did not show significant improvements in re-epithelialization for severe burns, nor did it enhance visual acuity or corneal clarity in either moderate or severe cases,” the researchers wrote in their study published in Ophthalmology Journal.

The amniotic membrane, known for its natural healing properties, provides a supportive environment for cell regeneration and tissue repair, making it a valuable option for ophthalmic interventions. Considering this, Peter B. Veldman, Department of Ophthalmology & Visual Science, The University of Chicago, Chicago, Illinois, and colleagues assessed the existing literature regarding the effectiveness of amniotic membrane grafting in treating acute chemical and thermal ocular surface burns, focusing on the rates of corneal re-epithelialization and the enhancement of visual acuity or corneal clarity.

For this purpose, the researchers conducted literature searches in the PubMed database in May 2023, with an update in January 2024, restricting the results to English language publications without date limitations. The searches led to 474 citations, of which 58 were reviewed in full text, and 9 met the inclusion criteria. Among these, four studies were rated as level II and five as level III. The assessment emphasizes three level II articles that reported consistent primary and secondary outcomes but exhibited suboptimal study designs, particularly concerning power calculations and the absence of a priori sample-size calculations.

The study led to the following findings:

  • Amniotic membrane grafting significantly enhanced corneal re-epithelialization compared to medical therapy alone in eyes with moderate-grade burns.
  • In cases of severely burned eyes, AMG showed no additional benefit over medical therapy.
  • AMG did not provide a significant advantage in improving visual acuity or corneal clarity for either moderate or severe ocular surface burns.

Level II studies provide evidence that amniotic membrane grafting (AMG) can effectively enhance the rate of corneal re-epithelialization in cases of moderate acute chemical and thermal ocular surface burns. As such, AMG may be considered a valuable adjunct to medical therapy for patients with moderate burns, potentially improving healing outcomes.

“However, these studies also reveal that AMG does not offer significant benefits over medical therapy in severe ocular surface burns, nor does it enhance visual acuity or corneal clarity in moderate or severe cases. It is important to interpret these negative findings within the context of study limitations, particularly regarding power, which may affect the reliability of the results,” the researchers wrote.

Reference:

Veldman PB, Greiner MA, Cortina MS, Kuo AN, Li JY, Miller DD, Shtein RM, Weikert MP, Yin J, Kim SJ, Shen JF. Efficacy of Amniotic Membrane Grafting for the Treatment of Chemical and Thermal Ocular Surface Injuries: A Report by the American Academy of Ophthalmology. Ophthalmology. 2024 Oct 9:S0161-6420(24)00514-1. doi: 10.1016/j.ophtha.2024.08.021. Epub ahead of print. PMID: 39387749.

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Root-Retained Overdentures Enhance Stability and Patient Satisfaction confirms Systematic Review

Greece: A recent systematic review of randomized controlled trials has shed light on the clinical parameters affecting the performance and patient satisfaction of root-retained overdentures (RODs).

The research, published in Gerodontology, revealed that despite the limitations of this systematic review, root-retained overdentures continue to be a valid treatment option, providing enhanced denture stability, better bone preservation around abutment teeth, and high levels of patient satisfaction.

“Maintaining good oral hygiene and scheduling regular follow-ups are essential for success. Additionally, more well-designed randomized controlled trials are needed to draw more definitive conclusions,” the researchers wrote.

Root-supported overdentures provide enhanced support, horizontal stability, improved retention, and better maintenance of proprioception and sensory feedback from the periodontal tissues, contributing to high patient satisfaction. As a successful treatment option for partially edentulous patients, RODs remain a viable alternative; however, conclusive evidence regarding their clinical evaluation is still lacking.

Against the above background, Aspasia Pachiou, Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece, and colleagues assessed the clinical parameters influencing the performance of root-supported overdentures and identified potential factors that may impact their effectiveness.

For this purpose, the researchers developed a search strategy based on the PIO (Population, Intervention, Outcome) framework, conducting an electronic search across several databases, including PubMed, Cochrane Library, and Scopus. This systematic search was limited to randomized controlled trials (RCTs) published in English until January 2023 and was carried out by two independent reviewers. The quality of the included studies was evaluated using the Cochrane Risk of Bias tool.

Findings from the Study:

  • The final selection comprised 11 randomized controlled trials (RCTs).
  • Clinically relevant variables identified included:
    • Complications: Caries were the most frequently reported complication.
    • Periodontal aspects and bone changes around abutment teeth.
  • Assessment of methods and clinical recommendations for maintaining these restorations.
  • Evaluation of patient-related outcomes.
  • Risk of bias assessment revealed:
    • Nine studies were classified as high risk.
    • Two studies were classified as low risk.
  • A meta-analysis was not feasible due to the study’s characteristics.

In conclusion, using protective or preventive agents can significantly reduce the risk of root caries. For individuals with root-supported overdentures, maintaining meticulous oral hygiene and attending regular follow-up visits are essential. Additionally, addressing the maintenance needs of both RODs and abutment teeth is crucial for ensuring the long-term success of these dental devices.

Reference:

Pachiou, A., Karakostas, P., Roulias, P., & Naka, O. (2024). Clinical parameters that affect performance and patient satisfaction of root-retained overdentures: A systematic review of randomised controlled clinical trials. Gerodontology, 41(3), 328-334. https://doi.org/10.1111/ger.12739

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Climate shifts and urbanisation drive Nepal dengue surge

Nepal is fighting a surge in dengue cases, a potentially deadly disease once unheard of in the country’s high-altitude Himalayan regions, as climate change and urbanization nurture fever-bringing mosquitoes in new zones.

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